Clarity on antibiotic prophylaxis against infective endocarditis

NEW implementation advice on antibiotic prophylaxis against infective endocarditis aims to clarify the "non-routine circumstances" in which such treatment might be justified.

The advice has been developed by the Scottish Dental Clinical Effectiveness Programme (SDCEP) to facilitate implementation of NICE Clinical Guideline 64 Prophylaxis against infective endocarditis and support dental teams in the routine care of patients at increased risk of infective endocarditis.

The advice emphasises the importance of including the patient in discussions about their care and provides information about identifying those increased-risk patients who may require special consideration for antibiotic prophylaxis/non-routine management.

It states: "The vast majority of patients at increased risk of infective endocarditis should not be offered prophylaxis. However, for a very small number of patients ['Patients Requiring Special Consideration'], it may be prudent to consider antibiotic prophylaxis in consultation with the patient and their cardiologist or cardiac surgeon".

The Faculty of General Dental Practice UK (FGDP(UK)) has endorsed the new advice. Dr Nick Palmer, editor of the FGDP(UK)’s Antimicrobial Prescribing for General Dental Practitioners, commented: "For over ten years the recommendations in NICE CG64, which apply to all healthcare professionals including cardiologists, have remained the same. These are that patients at increased risk of IE should be advised of the risks and benefits of prophylaxis, and that antibiotic prophylaxis is not routinely required for invasive dental procedures. The patient should also be advised of the symptoms of IE, of the importance of maintaining good oral health to reduce their risk of IE, and when to seek expert advice.

"SDCEP’s implementation advice re-emphasises the NICE CG64 recommendations, but notes that there are a very small number of dental patients that may require ‘special consideration’ for antibiotic prophylaxis. Importantly, SDCEP's implementation advice shifts the balance of responsibility for the decision on antibiotic prophylaxis for these patients from the dentist to the patient’s cardiologist and to the patient under Montgomery consent. Dentists should ensure they record in the clinical notes any advice from the patient’s cardiologist, and the patient's consent when a decision is made."

The implementation advice, along with supporting tools including patient information and a separate advice sheet for cardiology and cardiac surgical teams, can be accessed via the SDCEP website.